About Your Surgery

This guide will help you prepare for your salivary gland surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.

Your Salivary Glands

Your salivary glands make saliva, which helps your body digest food and keeps your mouth moist. Most of your saliva comes from the parotid, submandibular, and sublingual glands (see Figure 1). There are also hundreds of smaller salivary glands in your mouth. They are located under the membranes that line your mouth and throat.

Figure 1. Parotid, submandibular, and sublingual salivary glands

Parotid Glands

The parotid glands are the largest of all your salivary glands. They are located in front of your ears (see Figure 1). Your facial nerve runs through each parotid gland. This nerve controls the muscles in your face, which allow movements such as raising your eyebrows, closing your eyelids, and smiling. Most tumors found in the parotid gland are benign (not cancerous).

Submandibular Glands

The submandibular glands are the second largest of all your salivary glands. They are located below your mandible, or jawbone (see Figure 1). Most tumors found in the submandibular gland are benign.

Sublingual Glands

The sublingual glands are the smallest of all your salivary glands. They lie on either side of your tongue, in the floor of your mouth (see Figure 1). Most tumors found in the sublingual gland are benign. These tumors are rare.

Types of Surgery

The type of surgery you have for your salivary gland tumors depends on where the tumors are located. The different types of surgeries are described below. Your surgeon will tell you which surgery you are having.

Parotid Gland Surgery

Most salivary gland tumors are located in the parotid gland. There are 2 types of parotid gland tumors:

A superficial parotid gland tumor develops in the part of the gland that lies over your facial nerve.

A deep lobe parotid gland tumor develops in the part of the gland that lies under your facial nerve.

Surgery to treat parotid gland tumors is very precise. This is because your facial nerve needs to be protected during surgery. The goal is to remove the entire tumor without harming your facial nerve.

Your surgeon will use a nerve monitor to find your facial nerve. Once your facial nerve is located, your surgeon will make an incision (surgical cut) in the front of your ear, down into your neck. He or she will carefully separate your facial nerve and its branches from your parotid gland tumor. Your surgeon will carefully remove the parotid gland tumor and send it to the Pathology Department to see if it contains cancer cells. He or she will close your incision with sutures (stitches).

Submandibular Gland Surgery

Your surgeon will make an incision in your upper neck, along your jaw. He or she will remove the tumor through this incision and send it to the Pathology Department to see if it contains cancer cells.

Sublingual Gland Surgery

Sublingual gland tumors are rare. Your surgeon will tell you your options for treating this tumor.

Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare for your surgery.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medication to help prevent them.

If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.

Here are things you can do to prevent problems before your surgery:

Be honest with your healthcare provider about how much alcohol you drink.

Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.

Tell your healthcare provider if you cannot stop drinking.

Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.

I take prescription medications.

I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.

I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.

I have sleep apnea.

I have had a problem with anesthesia in the past.

I have allergies, including to latex.

I am not willing to receive a blood transfusion.

I drink alcohol.

I smoke.

I use recreational drugs.

About Smoking

People who smoke can have breathing problems and a higher risk of getting an infection when they have surgery. Smoking also slows would healing and increases the chance of problems with your reconstruction. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing

Before your surgery, you will be given an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.

Your nurse practitioner will talk with you about which medications you should take the morning of your surgery. To help you remember, we’ve left space for you to write these medications down in the “The Morning of Your Surgery” section of this guide.

It is very helpful if you bring the following with you to your PST appointment:

A list of all the medications you are taking, including patches and creams.

Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.

The name(s) and telephone number(s) of your doctor(s).

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.

Exercise

Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.

Eat a Healthy Diet

You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet talk to your doctor or nurse about meeting with a dietitian.

Stop Taking Herbal Remedies and Supplements

Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Sloan Kettering’s main hospital on the day of your surgery.

1 Day Before Your Surgery

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.

Both locations are at 1275 York Avenue between East 67th and East 68th streets.

Surgical Day Hospital (SDH)
M elevator to 2nd floor

Presurgical Center (PSC)
B elevator to 6th floor

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating and drinking before your surgery

Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.

Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).

Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.

The Morning of Your Surgery

Take Your Medications

If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

Things to Remember

Do not put on any lotions, creams, deodorants, makeup, powders, or perfumes.

Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.

Leave valuables, such as credit cards, jewelry, or your checkbook at home.

Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles.

If you wear contact lenses, wear your glasses instead.

Only the money you may need for a newspaper, bus, taxi, or parking.

Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.

Your breathing machine for sleep apnea (such as your CPAP), if you have one.

If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.

Your Health Care Proxy form, if you have completed one.

This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Parking When You Arrive

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar name may be having surgery on the same day.

Get Dressed for Surgery

You will be given a hospital gown, robe, and nonskid socks.

Meet With Your Nurse

Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.

You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.

After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

What to Expect

When you wake up after your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). You will stay there until you are awake and your pain is under control. Most people return to their room after a few hours in the PACU, but some will need to stay in the PACU overnight for observation.

You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You may have one or more of the following:

Drainage tubes to help drain fluid from your surgical wound.

A face mask and humidifier to keep your airway moist.

Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. After your stay in the PACU, you will be taken to your hospital room in the inpatient unit. There, your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.

It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.

Facial Changes

You may have some weakness in your facial muscles. This is because your facial nerve was moved during your surgery. Unfortunately, we cannot prevent this. This weakness is usually minimal and gets better over time. It can take weeks or months for your facial muscles to recover. If you have facial weakness, your nurse will show you how to do facial exercise that may speed up your recovery.

You may have some lower lip weakness, which may affect your smile. This may be permanent on your affected side (the side where your surgery took place).

You may not be able to fully close your eye on your affected side. You will be given ointment and eye drops to protect your eye.

You may have some numbness of the earlobe on your affected side. This may be permanent.

Commonly Asked Questions: During Your Hospital Stay

Will I have pain after my surgery?

People have very little pain after this surgery. Most people will have numbness, but it goes away with time. Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain is not relieved, tell your doctor or nurse. You will be given a prescription for pain medication before you leave the hospital. Pain medication may cause constipation (having fewer bowel movements than what is normal for you).

How can I prevent constipation?

Go to the bathroom at the same time every day. Your body will get used to going at that time.

If you feel the urge to go, do not put it off. Try to use the bathroom 5 to 15 minutes after meals.

After breakfast is a good time to move your bowels because the reflexes in your colon are strongest then.

Exercise if you can; walking is an excellent form of exercise.

Drink 8 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water, juices, soups, ice cream shakes, and other drinks that do not have caffeine. Beverages with caffeine, such as coffee and soda, pull fluid out of the body.

Slowly increase the fiber in your diet to 25 to 35 grams per day. Fruits, vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your doctor or nurse before making any changes in your diet.

Both over-the-counter and prescription medications are available to treat constipation. Start with 1 of the following over-the-counter medications first:

Docusate sodium (Colace®) 100 mg. Take _____ capsules _____ times a day. This is a stool softener that causes few side effects. Do not take it with mineral oil.

If you haven’t had a bowel movement in 2 days, call your doctor or nurse.

Will I be able to eat?

Yes, you will be on a mechanical soft diet right after surgery. A mechanical soft diet is made up of foods that require less chewing than in a regular diet. Chopped, ground, and puréed foods are included, as well as foods that break apart easily without a knife. Your diet will advance as you heal.

Eating a balanced diet high in protein will help you heal after surgery. Your diet should include a healthy protein source at each meal, as well as fruits, vegetables, and whole grains. For more tips on increasing the amount of calories and protein in your diet, ask your nurse for the resource Eating Well During and After Your Cancer Treatment. If you have questions about your diet, ask to see a dietitian.

Will I be able to make saliva?

Yes. Salivary gland surgery will not affect your saliva production.

How long will I be in the hospital?

Most people are in the hospital for 1 to 4 days after having salivary gland surgery. The length of your stay will depend on the exact surgery that is done.

Commonly Asked Questions: After You Leave the Hospital

Will I have pain when I am home?

The length of time each person has pain or discomfort varies. You may still have some pain when you go home and will probably be taking pain medication. Follow the guidelines below.

Take your medications as directed and as needed.

Call your doctor if the medication prescribed for you doesn’t relieve your pain.

Do not drive or drink alcohol while you are taking prescription pain medication.

As your incision heals, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil) will relieve aches and discomfort. However, large quantities of acetaminophen may be harmful to your liver. Do not take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse.

Pain medication should help you as you resume your normal activities. Take enough medication to do your exercises comfortably. Pain medication is most effective 30 to 45 minutes after taking it.

Keep track of when you take your pain medication. Taking it when your pain first begins is more effective than waiting for the pain to get worse.

Can I shower?

Yes, taking a warm shower is relaxing and can help decrease muscle aches. Use soap when you shower and gently wash your incision. Pat the areas dry with a towel after showering, and leave your incision uncovered (unless there is drainage). Call your doctor if you see any redness or drainage from your incision.

When will my sutures be removed?

Your sutures will be removed 7 to 10 days after your surgery, or at your first follow-up visit.

How do I care for my incision?

The location of your incision will depend on the type of surgery you had. It is normal to have numbness of the skin below the incision because some of the nerves were cut; this sensation will lessen over time.

By the time you are ready to leave the hospital, your surgical incision will have begun to heal.

You and your caregiver should look at your incision with your nurse before you leave the hospital so you know what it looks like.

If any fluid is draining from your incision, you should write down the amount and color. Call your doctor’s office and speak with the nurse about any drainage from your incision.

Change your bandages at least once a day and more often if they become wet with drainage. When there is no longer any drainage coming from your incision, they can be left uncovered.

If you go home with Steri-Strips™ on your incision, they will loosen and fall off by themselves. If they haven’t fallen off within 10 days, you may remove them.

If you go home with glue over your sutures, it will also loosen and peel off, similarly to the Steri-Strips.

When is it safe for me to drive?

You may resume driving after your first follow-up visit, unless otherwise directed by your surgeon.

What exercises can I do?

Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your doctor or nurse before starting more strenuous exercises.

When can I lift heavy objects?

Check with your doctor before you do any heavy lifting. Normally, you should not lift anything heavier than 10 pounds (4.5 kilograms) for at least 2 weeks. Ask your doctor how long you should avoid heavy lifting.

When is my first appointment after my surgery?

Your first appointment after surgery will be in 7 to 10 days after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

When will I get my test results?

Test results are usually ready in 1 week, but can take longer depending on the tests that will be done. Based on the results, you may need further treatment. Your doctor will discuss the results with you during your first follow-up appointment after your surgery.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It is always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you are in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

What if I have other questions?

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm.

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor on call for your doctor.

At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.

At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help referring you to community agencies and programs, as well as financial resources if you’re eligible.

Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that is part of the Good Days formulary.

If you have any questions or concerns, contact a member of your healthcare team directly or call 212-639-2000 for help.

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.